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Chronic pulmonary embolism

M Vafaie, E Giannitsis, H A Katus
Cardiac biomarkers are an integral part of the diagnostic work-up and risk stratification of patients with chest pain. Cardiac troponins are highly sensitive diagnostic biomarkers in patients with acute coronary syndrome and have prognostic value in a multitude of acute and chronic diseases. In patients with suspected pulmonary embolism (PE) D‑dimer can be used together with the Wells score for exclusion of PE. In patients with confirmed PE, B‑type natriuretic peptide (BNP), N‑terminal pro-BNP (NT-proBNP) and heart-type fatty acid binding protein (h-FABP) can be used for risk stratification...
June 21, 2018: Herz
L Huang, T Yang, W Li, X T Wang, C M Xiong, X H Ni, Q Gu, J G He
Objective: To analyze the clinical features of post-splenectomy pulmonary hypertension and effects of its target therapy, and improve the diagnosis and treatment of the disease. Methods: Clinical data of 18 patients with post-splenectomy pulmonary hypertension admitted to Fuwai Hospital from October 2006 to March 2017 were systematically reviewed and analyzed. Results: Among the 18 patients with a mean age of (41±11) years old, 11 were women and 7 were men. The interval between splenectomy and the diagnosis of pulmonary hypertension was (11±6) years...
June 12, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Sarosh P Batlivala, William E Briscoe, Makram R Ebeid
Systemic-to-pulmonary artery collateral networks commonly develop in patients with single-ventricle physiology and chronic hypoxemia. Although these networks augment pulmonary blood flow, much of the flow is ineffective and contributes to cardiac volume loading. This volume loading can have detrimental effects, especially for single-ventricle patients. Some data suggest that occluding collaterals may improve outcomes after subsequent operations, especially when the volume of collateral flow is significant. Traditional practice has been to coil occlude the feeding vessel...
May 2018: Annals of Pediatric Cardiology
Osama Mukhtar, Oday Alhafidh, Mazin Khalid, Jaspreet Kaler, Ebad Rahman, Binav Shrestha, Manal Bakhiet, Sumit Dahal, Bikash Bhattarai, Praveen Datar, Omar Abdulfattah, Vijay Gayam, Joseph Quist, Danilo Enriquez, Frances Schmidt
Introduction : The aim of our study is to determine the clinical, biochemical, and imaging factors that affect the duration of hospital stay in patients admitted with normotensive acute pulmonary embolism. Methods : This was a single-center retrospective study conducted in a community hospital in New York metropolitan area for patients admitted from October 2015 to October 2017. Results : A total of 79 patients were included, the mean age was 55.76 ( SD  = 17.33), 29 cases were males (37%) and 50 cases were females (63%)...
2018: Journal of Community Hospital Internal Medicine Perspectives
Shannon L Carpenter, Troy Richardson, Matt Hall
Although rare in children, pulmonary embolism (PE) can cause significant morbidity and mortality. Overall rates of venous thromboembolism (VTE) are increasing in hospitalized children. By using the Pediatric Health Information System database, we evaluated incidence, treatment, and outcome of PE in children younger than age 18 years from 2001 to 2014. Demographic characteristics for those admitted with VTE alone and those admitted with PE were compared. Rates of PE by year were compared with the number of hospital and VTE admissions...
June 26, 2018: Blood Advances
Jean-Philippe Collet, Sergio Berti, Angel Cequier, Eric Van Belle, Thierry Lefevre, Pascal Leprince, Franz-Josef Neumann, Eric Vicaut, Gilles Montalescot
BACKGROUND: Antithrombotic treatment regimen following transcatheter aortic valve replacement (TAVR) is not evidence-based. Apixaban, a non-vitamin K direct anticoagulant (NOAC) was shown to be superior to VKA and superior to aspirin to prevent cardioembolic stroke in non-valvular atrial fibrillation. It may have the potential to reduce TAVR-related thrombotic complications including subclinical valve thrombosis along with a better safety than the standard of care. DESIGN: ATLANTIS is a multicenter, randomized, phase IIIb, prospective, open-label, superiority study comparing standard of care (SOC Group) versus an apixaban-based strategy (Anti-Xa Group) after successful TAVR (ClinicalTrials...
June 2018: American Heart Journal
Furong Liu, Song Yang, Weishuo Liu, Baiyun Tang, Wenbo Zhang, Cheng Zhang, Wenwei Liao, Anbin Hu
Carbon monoxide (CO) poisoning, the most frequent type of poisoning, alters hemodynamics and creates tissue hypoxia that ultimately leads to thromboembolism. We herein describe a previously healthy 17-year-old male patient who developed acute CO poisoning while bathing in the same room as a gas heater. He was first treated with urokinase thrombolytic therapy at a local hospital, which proved ineffective. The patient was admitted to our hospital with unstable circulation and was diagnosed with massive pulmonary embolism combined with multiple organ dysfunction syndrome...
January 1, 2018: Journal of International Medical Research
Karel Novotný, Míla Roček, Radek Pádr, Radim Pavlík, Michal Polovinčák, Theodor Adla, Petra Zimolová, Jana Choi-Širůčková, Martin Weis, Simon Jirát, Vilém Rohn
BACKGROUND: Treating great and small saphenous vein trunk insufficiency with cyanoacrylate glue is the least taxing treatment method of all available techniques. Due to long-term unavailability of commercial kits with n-butyl-2-cyanoacrylate (histoacryl) in the Czech Republic, we used a modified technique. PATIENTS AND METHODS: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique...
June 12, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Alem Mehari, Norris Igbineweka, Darlene Allen, Jim Nichols, Swee Lay Thein, Nargues A Weir
Pulmonary hypertension (PH) in adults with sickle cell disease (SCD) is associated with early mortality. Chronic thromboembolic pulmonary hypertension (CTEPH) is an important complication and contributor to PH in SCD, but likely underappreciated. Guidelines recommend ventilation-perfusion scintigraphy (V/Q) as imaging modality of choice to exclude CTEPH. Data on V/Q are limited in SCD. Objective: To compare the performance of V/Q with computed tomography pulmonary angiography (CTPA) and to report clinical outcomes associated with abnormal V/Q...
June 7, 2018: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Meredith Turetz, Andrew T Sideris, Oren A Friedman, Nidhi Triphathi, James M Horowitz
Pulmonary embolism (PE) is a common and potentially deadly form of venous thromboembolic disease. It is the third most common cause of cardiovascular death and is associated with multiple inherited and acquired risk factors as well as advanced age. The prognosis from PE depends on the degree of obstruction and hemodynamic effects of PE and understanding the pathophysiology helps in risk-stratifying patients and determining treatment. Though the natural history of thrombus is resolution, a subset of patients have chronic residual thrombus, contributing to the post-PE syndrome...
June 2018: Seminars in Interventional Radiology
Carl Schümichen, Matthias Schmidt, Thomas Krause
The S1 guideline for lung scintigraphy has been updated and extended in order to emphasize the advantages oft the method in detecting acute pulmonary embolism (PE) in the periphery oft the lung (subsegmental PE), in underlying subacute and chronic pulmonary disorders, as well as in detecting chronic LE (CTEPH). Method of choice is ventilation / perfusion (V/P) SPECT or V/P SPECT/CT with even higher specificity. Because of its high sensitivity, a threshold (V/P mismatch in at least one segment or two subsegments) is introduced to avoid overtreatment...
June 2018: Nuklearmedizin. Nuclear Medicine
Romain Chopard, Guillaume Serzian, Sébastien Humbert, Nicolas Falvo, Mathilde Morel-Aleton, Benjamin Bonnet, Gabriel Napporn, Elsa Kalbacher, Laurent Obert, Bruno Degano, Gilles Cappelier, Yves Cottin, François Schiele, Nicolas Meneveau
Dose adjustment of direct oral anticoagulants (DOACs) is not required in the setting of acute PE treatment according to the manufacturer's labelling, beyond the contraindication in severe renal insufficiency. We designed a prospective, multicenter cohort study to investigate the impact of prescription of non-recommended DOAC doses on 6-month adverse events. The primary endpoint was a composite of all-cause death, recurrent VTE, major bleeding, and chronic thromboembolic pulmonary hypertension (CTEPH). In total, among 656 patients discharged with DOACs between 09/2012 and 10/2016, 28 (4...
June 4, 2018: Journal of Thrombosis and Thrombolysis
Elena A Kochmareva, Valentin A Kokorin, Ivan G Gordeev
OBJECTIVE: Pulmonary embolism (PE) remains one of the leading causes of mortality among cardiovascular diseases. We aimed at investigating risk factors of PE complications in patients with intermediate risk and integrate them into a simple model for its' bedside prediction. METHODS: Among 173 patients with PE, 136 were classified as high or intermediate risk. Patients were retrospectively divided into groups of complicated (n = 44) or uncomplicated (n = 92) course...
June 1, 2018: European Journal of Internal Medicine
Katherine A Trier, Demetra Pappas, Bryan Bovitz, Marilyn Augustyn
Ryan is a 6-year-old child new to your primary care practice after relocating from out of state with his father and younger sister. Ryan's grandmother recently expressed concerns about Ryan's social skills and behavior. He was subsequently diagnosed by a developmental and behavioral pediatrician with autism spectrum disorder, global developmental delay, and attention deficit hyperactivity disorder. At your first visit with Ryan, his father provides the following history: When Ryan was 3 years old, he was living with his mother and infant sister while his father was serving his fourth tour of duty with the marines in Afghanistan...
May 22, 2018: Journal of Developmental and Behavioral Pediatrics: JDBP
Ehtisham Mahmud, Michael M Madani, Nick H Kim, David Poch, Lawrence Ang, Omid Behnamfar, Mitul P Patel, William R Auger
Chronic thromboembolic pulmonary hypertension (CTEPH), a rare consequence of an acute pulmonary embolism, is a disease that is underdiagnosed, and surgical pulmonary thromboendarterectomy (PTE) remains the preferred therapy. However, determination of operability is multifactorial and can be challenging. There is growing excitement for the percutaneous treatment of inoperable CTEPH with data from multiple centers around the world showing the clinical feasibility of balloon pulmonary angioplasty. Riociguat remains the only approved medical therapy for CTEPH patients deemed inoperable or with persistent pulmonary hypertension after PTE...
May 29, 2018: Journal of the American College of Cardiology
Francisca Alexandra Gavilanes-Oleas, Jose Leonidas Alves, Caio Julio Cesar Fernandes, Luis Felipe Lopes Prada, William Salibe Filho, Mario Terra Filho, Luciana Morinaga, Susana Hoette, Carlos Jardim, Rogerio Souza
OBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension...
May 17, 2018: Clinics
Jeffrey Forris Beecham Chick, Ravi N Srinivasa, Kyle J Cooper, Neil Jairath, Anthony N Hage, Brooke Spencer, Steven D Abramowitz
Iliocaval thrombosis, or thrombosis of the inferior vena cava and iliac veins, is associated with significant morbidity in the form of limb-threatening compromise from phlegmasia cerulean dolens, development of post-thrombotic syndrome, and death secondary to pulmonary embolism. Endovascular iliocaval reconstruction is an effective treatment for iliocaval thrombosis with high levels of technical success, favorable clinical outcomes and stent patency rates, and few complications. It is often able to relieve the debilitating symptoms experienced by affected patients and is a viable option for patients who fail conservative management...
June 2018: Techniques in Vascular and Interventional Radiology
Menno V Huisman, Stefano Barco, Suzanne C Cannegieter, Gregoire Le Gal, Stavros V Konstantinides, Pieter H Reitsma, Marc Rodger, Anton Vonk Noordegraaf, Frederikus A Klok
Pulmonary embolism (PE) is caused by emboli, which have originated from venous thrombi, travelling to and occluding the arteries of the lung. PE is the most dangerous form of venous thromboembolism, and undiagnosed or untreated PE can be fatal. Acute PE is associated with right ventricular dysfunction, which can lead to arrhythmia, haemodynamic collapse and shock. Furthermore, individuals who survive PE can develop post-PE syndrome, which is characterized by chronic thrombotic remains in the pulmonary arteries, persistent right ventricular dysfunction, decreased quality of life and/or chronic functional limitations...
May 17, 2018: Nature Reviews. Disease Primers
Paola Faverio, Federica De Giacomi, Luca Sardella, Giuseppe Fiorentino, Mauro Carone, Francesco Salerno, Jousel Ora, Paola Rogliani, Giulia Pellegrino, Giuseppe Francesco Sferrazza Papa, Francesco Bini, Bruno Dino Bodini, Grazia Messinesi, Alberto Pesci, Antonio Esquinas
BACKGROUND: Interstitial lung diseases (ILDs) are a heterogeneous group of diseases characterized by widespread fibrotic and inflammatory abnormalities of the lung. Respiratory failure is a common complication in advanced stages or following acute worsening of the underlying disease. Aim of this review is to evaluate the current evidence in determining the best management of acute respiratory failure (ARF) in ILDs. METHODS: A literature search was performed in the Medline/PubMed and EMBASE databases to identify studies that investigated the management of ARF in ILDs (the last search was conducted on November 2017)...
May 15, 2018: BMC Pulmonary Medicine
Daniel G Whitney, Edward A Hurvitz, Jennifer M Ryan, Maureen J Devlin, Michelle S Caird, Zachary P French, Elie C Ellenberg, Mark D Peterson
Purpose: Individuals with cerebral palsy (CP) are at increased risk for frailty and chronic disease due to factors experienced throughout the lifespan, such as excessive sedentary behaviors and malnutrition. However, little is known about noncommunicable diseases (NCDs) and multimorbidity profiles in young adults with CP. The study objective was to compare NCD and multimorbidity profiles between young adults with and without CP. Methods: A clinic-based sample of adults (18-30 years) with (n=452) and without (n=448) CP was examined at the University of Michigan Medical Center...
2018: Clinical Epidemiology
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